Regarding the letter “Reader Sees No Miracle in Latest Drug” (March/April 2006 issue), it is tragic that many addiction specialists still endorse an obsolete spiritual, purist “disease” model, assuming that abusers have to stop every medication and rely on AA/NA.
It is time to redefine addiction and improve our treatment philosophy. Abuse is an activity that is pursued to feel good, or at least better, even though in the big picture it is “bad.” Abusable drugs make people feel good by imitating the feeling of having fulfilled something instinctively or culturally meaningful. Tranquilizers feel like having completed a day's work and deserving to relax in the midst of conflicts; psychostimulants feel like being about to reach some exciting point or being able to solve all problems; opiates feel like being suddenly accepted and nurtured by family or clan while socially isolated. When it becomes a first priority and competes with care of children, love, work, etc., the abuse becomes an addiction.
By definition, nicotine patches, buprenorphine, and methadone are treatments, not substitute habits. These medications are not replacing a high, but suppress the craving and the reward of the drugs, if there is a lapse. They give a physiologically dependent person time to make psychological changes. If a medication leads the person to feel better, it can be compared to a healthy meal eaten by an obese junk food addict.
Maintenance medications do not interfere with thinking, but promote functioning and growth. Methadone maintenance has been reconfirmed as the “gold standard” in the treatment of opiate addiction, even if some methadone programs do not individualize dosages adequately and/or offer minimal education and counseling.
The 12 Steps of AA/NA are based on a model of addiction that is not scientific but is valuable for certain addicts. But for many depressed women who got into drugs because they felt out of control, the concepts of “giving up control” and “turning their life over to God” sound absurd. Sometimes meetings and proselytizing become addictions—an escape from more meaningful activities.
The notion that painful withdrawal promotes progress is absurd. The vast majority of people who go through painful withdrawal, in jail or detox units, relapse. Regarding pain, nobody ever advocated physical punishments to help food addicts stop their behaviors. “Hitting bottom” is a false concept. As Garrison Keillor said, “I thought I hit bottom, but it was only a ledge.” Things could always get much worse.
Heinz Aeschbach, MD, Medical Director, Addiction and Psychotherapy Services, Austin, Texas